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Diagnosis and exclusion of gonorrhoea in women
  1. D Barlow
  1. Lydia Department, Department of Genitourinary Medicine, St Thomas’s Hospital, London SE1 7EH, UK; david.barlowgstt.sthames.nhs.uk

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    The recent report1 of the death of rectal and throat sampling in women was an exaggeration. I write lest anyone think there has been a conversion from long held,2,3 and recently reiterated4,5 views. Bradbeer and Mears questioned the utility of taking rectal and throat swabs in female gonorrhoea contacts by reference to a poster presentation, of which I was a co-author, at the IUSTI Asia-Pacific Conference 2002.6

    In this poster the conclusion stated that: “At this clinic rectal microscopy and culture, and throat culture in women did not aid diagnosis. There appears to be a general reduction in the usefulness of these tests since the last major assessment.” The authors offered one possible explanation (of several) for this but did not conclude (as implied by Bradbeer and Mears’ citation) that these investigations could be abandoned.

    While it is vital that we have sensitive and specific methods for diagnosing STIs, including gonorrhoea, we have always, even during the post-war mode of gonococcal incidence, the mid-1970s, spent most of our time excluding gonorrhoea. We need to be able to tell, with confidence, those who ask us, that they have not got gonorrhoea. Further, we need to be able to reassure those treated that the infection has been eliminated. One conclusion from our study, which we hope to publish after peer review, may well be that the testing protocols adhered to in 2001 were inadequate to exclude gonorrhoea. Their adequacy would not improve were we to abandon samples from rectum and oropharynx.

    For the record, the correct citation (their reference 11) and order of authors is as given here.6 We did not suggest limiting swab sites to the urethra and cervix; the number of rectal investigations was not (as implied) 338, but 115 by culture and 94 by microscopy; throat swabs numbered 119. Finally, we did not see “338 cases of female contacts of GC.” The number of female contacts of gonorrhoea seen and reported in our series was 101.

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